Individual
MRS. JENNIFER ERIN EDMONDSON
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
LPC, LADC, CMIII
Contact information
Practice address
1601 S STATE ST STE 100, EDMOND, OK 73013-3507
(405) 315-7093
Mailing address
1601 S STATE ST STE 100, EDMOND, OK 73013-3507
(405) 315-7093
Taxonomy
Speciality
Code
Description
License number
State
101Y00000X
Counselor
Primary
5028
OK
101YA0400X
Addiction (Substance Use Disorder) Counselor
1067
OK
103K00000X
Behavior Analyst
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
200370610B
—
OK
Enumeration date
06/09/2011
Last updated
06/11/2019
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